Creating a System of Care for California’s Dual Eligible Population

Today’s guest blogger is former ITUP Policy Director, Adam Dougherty. Adam is now a second year medical student at UC Davis.

Greetings from UC Davis School of Medicine! Though I am no longer in the health policy world full time, it has been a real privilege living in Sacramento, which has allowed me to remain active in advocacy and other efforts. This past summer, I had the opportunity to intern at the Department of Health Care Services under their new Medical Director, Dr. Neil Kohatsu. With so much going on in health reform implementation, it was an exciting time to be involved at DHCS on a day-to-day basis.

In my work at the Department, I developed a report entitled Cost Containment Strategies for California’s Dual Eligible Population. The dual eligible population, individuals who qualify for both Medicare and Medicaid, is a particularly vulnerable subset of America that must navigate a severely fragmented delivery system. While representing only 16% and 18% of the Medicare and Medicaid populations respectively, duals account for 24% and 46% of each program’s total spending. In all, health care for duals is roughly 10% of national health spending, and this number will continue to rise as the baby boomer generation ages.

The inefficiencies and disincentives that plague the delivery of care for this population, in addition to unprecedented flexibilities offered through the Affordable Care Act, provide California with ample opportunity to improve care for duals while lowering overall costs. In a time of perpetual budget crises and unpredictable program cuts, California is well positioned to streamline care for one of the costliest and most vulnerable populations. This special DHCS report provides an overview of California’s dual population as well as several forward thinking strategies in this regard, including federal collaboration, payment reform mechanisms, quality measure improvement, health information technology, and prevention.